Edging into 2018, Could 2017 Turn Out To Have Been an Inflection-Point Year? | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

Edging into 2018, Could 2017 Turn Out To Have Been an Inflection-Point Year?

January 1, 2018
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It feels as though 2017 was an important year in the preparation on the part of advanced patient care organizations, to plunge more deeply into risk-based contracting

New Year’s Eve and New Year’s Day always provide excellent opportunities for journalists to look, Janus-like, backwards into the recent past, and forward into the immediate future, and the flipping of the calendar from 2017 to 2018 is no exception.

The big-picture reality? As we enter 2018, the leaders of the most advanced multispecialty medical groups are absolutely skating to where the puck is headed in U.S. healthcare, leveraging data analytics, and aligning incentives, in order to take on increased risk in risk-bearing contracts. Indeed, for those who closely observed key trends in 2017, it has been clear that is those advanced physician organizations that are pointing the way, as we edge into 2018, facing an operating environment with accelerating policy, business, and IT-strategic challenges.

As Managing Editor Rajiv Leventhal reported in a December 13 article, “Medical groups and health systems that are members of AMGA (the American Medical Group Association) expect that nearly 60 percent of their revenues from Medicare will be from risk-based products by 2019, according to the results from a recent survey.” Leventhal noted that AMGA’s third annual risk survey, which encompassed complete responses from 74 of that association’s member medical groups, found that, “[I]f Medicare Advantage, bundled payments, Medicaid managed care organizations, and Medicare accountable care organizations (ACOs) are factored together, alternatives to Medicare fee-for-service (FFS) are predicted to account for 59 percent of AMGA member’s revenues by 2019, compared to 53 percent in 2017.”

Granted, AMGA’s member medical groups by and large represent the most advanced, as well as the largest, independent multispecialty medical groups operating in the U.S.; further, lumping Medicare Advantage contracts together with bundled-payment contracts and participation in the MSSP (Medicare Shared Savings Program) for ACOs is a bit facile. That said, the fact that the most sophisticated medical groups anticipate three-fifths of their revenues to come from risk, within the next year, is quite significant indeed.

Meanwhile, what did AMGA member-group executives cite as the number-one impediment to taking on risk? The white paper, entitled “Taking Risk, 3.0: Medical Groups Are Moving to Risk … Is Anyone Else? AMGA’s Third Annual Survey on Taking Risk,” noted that “The most critical obstacles involve data, particularly the lack of access to administrative claims data, health plan data that is not actionable, and reporting data to duplicative quality measurement programs. Internal impediments revolve around the need to develop and finance the infrastructure necessary to take risk.”

In our editorial team’s reporting, we’ve found consistently, in interviewing provider leaders over the past year, that a lot of really basic “blocking and tackling” elements of leveraging data—and especially of “marrying” clinical and claims data—remain core obstacles to improving performance in risk-based contracting. Indeed, that issue remains one of the biggest day-to-day problems for both hospital and medical group leaders moving into risk.

Perhaps that’s why the actual, practical planning for the implementation of artificial intelligence-based development work in patient care organizations has not yet reached the level of prioritization that might be expected. As Associate Editor Heather Landi reported on December 7, “A new survey provides some insight into how hospital and health system leaders are prioritizing healthcare technology investments for next year with strong indications that healthcare leaders are focused on investing in proven technology solutions that will have an immediate impact, and are proceeding cautiously with emerging technology like artificial intelligence (AI). The survey, conducted by the Pittsburgh-based Center for Connected Medicine (CCM) in partnership with the Health Management Academy, reflects the opinions of healthcare C-suite leaders from 20 major U.S. health systems across the country.”

Interviewing Gary Bisbee Jr., Ph.D., co-founder, chairman and CEO of the Health Management Academy, and Bryan Clutz, Ph.D., researcher director at the Academy and Melissa Stahl, research manager, about the implications of the survey’s findings, Landi wrote, “An overall emerging theme from the survey was that while health system leaders are excited about the prospects of emerging technologies such as AI and machine learning, yet the majority are proceeding cautiously on these technologies and continue to be focused, instead, on proven technologies and IT initiatives, such as enhancing existing electronic health record (EHR) systems, standardizing IT platforms and cybersecurity solutions.”

As the article noted, “[T]he survey found that more than half of health systems currently use AI, but 63 percent of hospital IT executives ranked the implementation of AI solutions as a ‘low’ or ‘very low’ priority for 2018. Executives reported that AI is in its early stages where proving its value is difficult and the technology still needs refinement, but they expect the technology to have greater impact in the future, according to the survey report. And, responding health systems expect to spend an average of 2.6 percent of their IT budget on AI in 2018.”

As Landi noted, “In the report, one CIO who was interviewed said: ‘I think that health care is still figuring out how to get value from data in general. We have use cases, but they are not ubiquitous. Until data is ubiquitous, it makes AI hard to prioritize. Additionally, it’s great to predict something but if you don’t have a corresponding intervention it doesn’t do much. It’s interesting, but still an experiment.’”

All of that makes a lot of sense, and speaks to where the industry really is right now—at an important inflection point, if a relatively early one, in the plunge towards the “deep end of the pool,” with regard to population health management and risk-based contracting.

As I noted in our July/August cover story, “[T]he leaders of more advanced medical groups… are already involved in taking on some level of financial risk in risk-based contracting, whether through federal accountable care organizations (ACOs) or ACOs sponsored by private health insurers, or through bundled-payment contracts (again, federal or private), or through any one or more of a broad range of population health-focused contracts of all kinds. And these medical group leaders have been spending the last few-to-several years learning how to collect and analyze data and use that data to feed continuous clinical and operational performance improvement, while at the same time building learning organizations, and transforming the physician cultures in their organizations.”

Jeffrey LeBenger, M.D., CEO of the Berkeley Heights, New Jersey-based Summit Medical Group, one of the most advanced medical groups of its kind in the U.S., put it very succinctly to me, when he said, ““Everybody says it’s population health, population health,” he says, referring to the current focus on population health management strategies. “To be honest, I think that’s a bit wrong. You have to look at your model of healthcare. We’re getting very close to 800 providers; we’re in seven counties. And what we’ve done is that we’ve created high-acuity urgent care centers with imaging and with specialists; and we’ve created high-risk clinics for our high-risk patients. We do transitions of care for our sickest 5 to 10 percent of patients. We have home healthcare. We have medical directors at 70 percent of the long-term facilities we’re in. We compensate based on outcomes. And we follow the patient-centered medical home concept; and we really manage the patients out of the hospitals. For us, a hospital is a center for tertiary or quaternary care. We look very closely at monitoring patients out of the hospital.”

In other words, put simply, Dr. LeBenger and his fellow physicians at Summit Medical Group are looking ahead to the future of U.S. healthcare, when multispecialty medical group-based care management will be the core of the focus of the healthcare system, particularly for patients with chronic conditions; and in which averting inpatient hospitalizations and emergency department visits, will be the norm, not the exception.

Analytics interest is surging—for good reason


Meanwhile, the leveraging of analytics to support population health management and care management appropriately leapt to the forefront in 2017. And that leveraging is getting more and more sophisticated. As Scott Hines, M.D., the chief quality officer at Crystal Run Healthcare, the 400-plus-physician group based in the Hudson Valley town of Middletown, New York, told me, in an interview for the same cover story, “When we were relying solely on the payers’ claims data, there was at least a three-month delay/lag,” he says. “So we asked for specific numerators and denominators from the payers, for each of their measures.” In this context, the denominator is the patients included in a measure, and the numerator is the subgroup of patients that the health plan involved has determined are compliant with a particular measure. “And we take that information and feed it into our payer quality scorecard, and that captures any internal data, and shows us where we are in real time on those measures. We’re trying not to have any surprises, so that the payer says, for example, your benchmark was 75 percent for breast cancer screening, and you only hit 72 percent—that kind of thing.”

In that regard, it should surprise no one that recent surveys have shown that healthcare CIOs are focusing on leveraging analytics in the near future.

As Heather Landi reported in a December 20 story, 40 percent of hospital CIOs surveyed by the Springfield, Va.-based Spok, on behalf of the Ann Arbor, Mich.-based CHIME (College of Healthcare Information Management Executives) indicated this summer that “deploying an enterprise analytics platform is a top priority in 2018. Seventy-one percent of respondents,” the survey found, “cited integrating with the EHR is a top priority, and 62 percent said physician adoption and buy-in for securing messaging was a top priority in the next 18 months. What’s more, 38 percent said optimizing EHR integration with other hospital systems with a key focus for 2018.”

Facing up to the cybersecurity-threat tsunami

All of these surveys speak to the reality that all of the trends in U.S. healthcare—with one exception—are heading in the same direction—around the collection, analysis, and sharing of data, in order to allow providers to participate successfully in risk-based contracting, population health management, and care management.

The one exception? The massive cybersecurity challenge, which is forcing healthcare IT leaders to think in the “opposite direction”—in terms of protecting PHI (protected health information) on behalf of patients, in the face of a rising tsunami of cyber threats from all sources.

As Rajiv Leventhal noted in a December 20 news story, a new report from Black Book has found that “More than eight in ten provider organizations lack a reliable enterprise leader for cybersecurity, while only 11 percent plan to get a cybersecurity officer in 2018.” Indeed, he reported, “The survey revealed that the healthcare industry continues to underestimate security threats as attackers continue to seek data and monetary gain, researchers attested. "The low security posture of most healthcare organizations may prove a target demographic for which these attacks are successful," said Doug Brown, managing partner of Black Book. What’s more, 92 percent of the C-suite officers surveyed stated that cybersecurity and the threat of data breach are still not major talking points with their board of directors. And 15 percent of all healthcare organizations responding to the survey said they are taking cybersecurity seriously by having a chief information security officer (CISO) in charge now.”

As Doug Brown, a managing partner at Black Book, was quoted as saying that “Cybersecurity has to be a top-down strategic initiative as it’s far too difficult for IT security teams to achieve their goals without the board leading the charge.”

And the growing danger is real: as Leventhal reported on December 13, “Eighty-three percent of physicians in a recent survey said that they have experienced some sort of cyber attack, such as phishing and viruses, while 55 percent of respondents said they are “very worried” about future cyber attacks on their organizations. This latest research on healthcare cybersecurity, from Accenture and the American Medical Association (AMA), surveyed 1,300 physicians across the U.S. this summer regarding their experiences and attitudes toward cybersecurity. The findings suggest ‘a strong need for improved cybersecurity education for physicians,’ according to the researchers.”

In a strange sort of way, those survey results take us back to the core trends, in that physicians in practice will increasingly be turning to CIOs, CMIOs, and other healthcare IT leaders in hospitals and health systems to help them meet confront their cybersecurity challenges, as the doctors in onesie-twosie practices are woefully unprepared for the cybersecurity tsunami.

And even smaller hospitals will increasingly turn to consolidation within large health systems in order to survive the massive cybersecurity challenge facing the industry.

Finally, one thing is absolutely clear: provider leaders face an increasingly challenging policy and payment landscape going into 2018. The comprehensive tax bill passed by Republicans in Congress and signed into law in December by President Trump, presages potentially significant Medicare reimbursement cuts, as the growth in the deficit occasioned by the tax cuts involved in the bill is emboldening some in Congress to push for Medicare cuts.

And with the ongoing aging of the U.S. population and the explosion in chronic conditions, there is no question whatsoever that federal policy leaders, including members of Congress, will push for new ways to control the inevitably growing cost of U.S. healthcare. So those provider leaders who are preparing to plunge more deeply into risk-based contracting, are absolutely skating to where the U.S. healthcare puck is inevitably headed.

In any case, best wishes to everyone, as we skate into 2018!




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Nemours Children’s Health’s New CEO: “The Most Exciting Time in Healthcare”

October 12, 2018
by Mark Hagland
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Nemours Children’s Health’s new CEO, R. Lawrence Moss, spoke with Healthcare Informatics about the opportunities and challenges facing children’s healthcare providers

On June 5, the Nemours Children’s Health System, based in Wilmington, Delaware, and with care locations in the Delaware Valley region and Florida, announced that R. Lawrence Moss, M.D., had been named the organization’s next president and CEO. An announcement posted to the organization’s website stated that “The Board of Directors of the Nemours Foundation today announced Dr. R. Lawrence Moss has been selected to succeed Dr. David Bailey as the President and CEO of Nemours Children’s Health System. Dr. Moss will begin his tenure October 1, 2018. Dr. Moss, a renowned pediatric surgeon, biomedical researcher, educator, and health system executive. He is internationally recognized for leadership in healthcare quality and safety, including service as a founding director for developing quality standards for pediatric surgery nationally. He is also known for with tremendous achievements in academic health centers, national hospital associations, and government organizations accountable to the public. He joins Nemours after serving seven years as Surgeon-in-Chief at Nationwide Children’s Hospital in Columbus, Ohio, and the E. Thomas Boles Jr., Professor of Surgery at The Ohio State University College of Medicine.”

The announcement went on to say that "Dr. Moss brings unique experiences as a physician leader in academic health centers, and he embodies the character of Nemours, a health system dedicated to continuous learning and improvement," said Brian Anderson, Chairman of the Board of Directors of the Nemours Foundation. "In addition to his clinical roles, he brings invaluable perspective and expertise in the development and execution of value-based care focused on the overall health of children through collaboration with payers and government agencies. The Board is pleased that Dr. Moss will continue fulfilling our mission to meet the needs of children, families, and the communities we serve."

R. Lawrence Moss, M.D.

"The President and CEO role at Nemours represents a wonderful opportunity to lead an institution that embodies the values I hold as most important to the future of American healthcare," Dr. Moss said in a statement included in the June 5 announcement. "With a focus on creating health over treating disease, efficient care delivery and an alignment of the success of the medical center with the health of the population it serves, I believe that Nemours is in an optimal stage of development to offer the next leader the opportunity to catalyze a quantum step forward."

As the organization’s website notes, “Nemours is an internationally recognized children's health system that owns and operates the two free-standing children’s hospitals: the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and Nemours Children's Hospital in Orlando, Fla., along with outpatient facilities in five states, delivering pediatric primary, specialty and urgent care. Nemours also powers the world’s most-visited website for information on the health of children and teens, KidsHealth.org, and offers on-demand, online video patient visits through Nemours CareConnect. Nemours ReadingBrightstart.org is a program dedicated to preventing reading failure in young children, grounded in Nemours’ understanding that child health and learning are inextricably linked, and that reading level is a strong predictor of adult health.”


Integrating Data Sources for Successful Care Delivery

The advances in and availability of data from disparate sources create new opportunities and frontiers in care coordination for complex patients. These can range from mobile health/Internet of...

On October 1, Dr. Moss officially joined the organization, replacing David Bailey, M.D., who retired following 12 years as Nemours’ CEO. On October 11, during a break in a one-day conference presented by the Nemours organization entitled “Pediatric Moneyball: Technology, Consumerism & Population Health,” focused on the opportunities and challenges facing our healthcare system, our communities, and our society in caring for children and improving their health and wellness, Dr. Moss, along with Gina Altieri, senior vice president and chief of strategy integration at Nemours, sat down to speak with Healthcare Informatics Editor-in-Chief Mark Hagland regarding their perspectives on the landscape around children’s healthcare in the present moment. Below are excerpts from that interview.

Strategic planning has never involved higher stakes than it does these days at children’s hospitals operating in the United States. Can you speak to this moment in U.S. healthcare? How does it strike you right now?

R. Lawrence Moss, M.D.: I’ve been doing this for a long time, and I have to say that this is the most exciting time in healthcare at any time in my career. I think it’s fantastic, because we have the opportunity to address and fix the two biggest problems I’ve seen in my career. We have the opportunity to align the finances of the system with the health of the patient; it’s been totally backwards. When a child needs more treatment, the system benefits. But finally, we have society’s attention and focus on, how do we create a situation where the child stays healthy, the family wins, and the system wins? Dr. Bailey, my predecessor, said it so well this morning, that health is so much more than healthcare. And we can be more than we’ve been; and we aspire to do that.

Children’s hospitals are facing payment challenges as never before. What do you see as the keys to their survival in the current reimbursement environment?

Dr. Moss: First of all, as children’s hospitals, we need to do a better job of articulating our value to society. We bring enormous value to society, and a lot of folks don’t know that. And we’ve got to get better at telling that story; it’s the greatest story in the world. Secondly, we need to more effectively partner with our government partners, because 60 percent of the children whose healthcare is funded, it’s funded through the government. Third, we need to be able to use the massive advances in technology to bring HC to the patient, in the way that the patient and family needs.

Gina Altieri: I agree that technology can enable a lot of the collaboration—even as our last panel was talking about how we get to where the children are, and partner with others, and bring the provider to the family that might be in a rural area, and might not have easy access to care, for example.

Gina Altieri

We’ve been so health system-centric, rather than patient- or family-centric, until recently, as a U.S. healthcare system.

Altieri: Yes, we shifted from provider-centric to consumer-centric, in developing [KidsHealth.org and the Nemours CareConnect]. We did that with design thinking, and we really did partner with families early on. We had our providers, families, and technical people early on, to understand their needs.

Moss: A really interesting thing I learned a really interesting thing at dinner last night, talking to a strategic consultant over dinner. He showed some data about the use of smartphones—that those are actually disproportionately used by the most disadvantaged parts of society.

Altieri: And it’s a misconception that disadvantaged people don’t use technology.

How do you look at technology, at the investment involved, and what can be achieved with it?

Moss: I look at it as a tool to achieve what we want to achieve. Innovation being the intersection between science and humanity, what Walter Isaacson said this morning [journalist, author, biographer and historian Walter Isaacson had delivered a presentation to the Pediatric Moneyball audience on Thursday morning]. It’s wonderful to have the technology, but unless we have the humanity to know how to use it, we won’t advance. What Nemours brings to the table, and the people in this organization bring to the table, is the ability to understand and care about what children really need.

Altieri: From a budget or investment perspective, we did recognize 20 or so years ago that this cost of investing in this technology was an investment in our future, and that we needed to look at this as a long-term investment. And we’re far beyond initial investment in an EMR, for example.

Moss: We’re cognizant of the investment, and it’s well worth it.

And you and your colleagues have achieved significant improvement in patient and family satisfaction, through the technology-facilitated advances you’ve made at Nemours.

Yes, we’re very proud of our patient and family satisfaction.

And how does the investment in and development of technology, for telehealth and other purposes, support the shift into value-based healthcare?

Altieri: Yes, and in addition to improving the experience for families, we recognized that we really did need to come up with alternatives that were less costly. We did surveying and found that 60 percent of families would have gone to the ED without the telehealth.

What do you see as your biggest challenges and opportunities in the next few years?

Moss: I prefer to talk about opportunities. The opportunities are to play a major leadership role in what children’s healthcare looks like tomorrow in this country. We are a multiple state organization; our patients come from the most disadvantaged and the most privileged backgrounds. We are a microcosm of the country, and when we get it right, it will be important.


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NLM’s Flatley Brennan to Receive AMIA’s Morris Collen Award

October 11, 2018
by David Raths, Contributing Editor
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She spearheaded efforts on including patient-generated data in EHRs

Patricia Flatley Brennan, R.N., Ph.D., director of the National Library of Medicine, will be awarded the 2018 Morris F. Collen Award of Excellence by the American College of Medical Informatics (ACMI).

The award is given each year at the AMIA Symposium in honor of Morris F. Collen, a pioneer in the field of medical informatics at Kaiser Permanente. It is presented to an individual whose personal commitment and dedication to medical informatics has made a lasting impression on the field. 

Brennan is widely recognized for her abilities to repurpose commercial technologies to improve the safety and effectiveness of health service delivery systems, according to AMIA.  She developed a first of its kind technology-based home care service for persons living with AIDS in the 1980s. She also worked to develop home care technologies to support elder caregivers, people recovering from cardiac surgery and patients with chronic heart disease. Her work had a profound impact on future development of technologies used for in-home chronic illness management.

She also spearheaded the biomedical informatics efforts that led to the federal requirement that electronic health records systems must safely and effectively include patient-generated and patient-sourced data. Patient access to information is now a core part of the CMS EHR incentive program.

Brennan has been elected to the American Academy of Nursing, the American College of Medical Informatics, the National Academy of Medicine, and the New York Academy of Medicine. She has also been honored with the AMIA Leadership Award and the AMIA Virginia K. Saba Award.



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Why A.I. Will Never Replace Recruiters

September 12, 2018
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AI can be a great tool, but recruiters aren’t going away

I remember fear settling in like a big dark cloud when I opened my search practice in 2005 with all the dire predictions of how the Internet and all the online hiring websites were going to put recruiters out of business. Many articles were written on the demise of the recruiter as Monster.com would literally scare us out of business.

Then came other job opening aggregators like Indeed.com, ZipRecruiter and a whole host of other websites chasing HR gold as if there was a switch they could simply flip to eliminate the human touch that recruiters bring to the table with engaging candidates, only to be replaced by a text message alert or an email notification of all the new jobs that were now open. The only thing they were missing were qualified applicants.

These predictions never came true and all the prognosticators simply forgot what recruiters actually do every day that their technologies will never replace. CIOs need to remember the critical nature of hiring leaders and team members for key roles in their organization. Candidates need to be vetted and coached to listen to an opportunity to join your team when we call the candidates. You have to remember:

  • We talk with people. Yes, we use a cell phone, or now a VOIP phone, and actually engage in a dialogue with candidates about opportunities. It’s a novel approach—I get it.
  • We engage with people that will never look on those job posting sites because they are not looking for a new job. Period.
  • We contact passive candidates that up until our call were never going to leave their job because they are so focused on the now that they don’t even think about looking on a website for a job they are not even interested in.
  • We help clients and candidates come together on the right offer and provide two-way communication during the hiring process, so each party has a deep understanding of the other party’s point of view. Online sites—well you get the picture…
  • We hammer out the details of relocation packages with our clients and the candidates and their families to make sure the move is done smoothly to allow the family to begin their transition to a new city. It’s the personal touch that matters here because we are dealing with people’s lives.

Fast forward: The next wave of artificial intelligence (AI) products for hiring are cropping up everywhere and we are hearing similar calls for recruiters to give up and retreat as the latest algorithm and data analytics tools are able to speed up the hiring process supplanting recruiters. Within seconds, these tools are touting they can determine who the perfect candidates are based on the analytics and machine learning tools designed for hiring. Guess what? It won’t happen.

AI can be a great tool, but it falls dreadfully short of meeting hiring managers' expectations. It won’t wave a magic wand suddenly making hiring enjoyable and much quicker with the same quality as the work performed by most search firms. I’ve been in technology in some form or fashion for a very long time. I love technology and what technology can do to speed up productivity and actionable data I can use every day in the work we do. It’s awesome!

But to be clear, I’m not going away. I have seen this movie before and I am fairly certain I can tell you how it ends. The work recruiters do to find and recruit great talent is something humans must do.

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